Conversion from Roux-En-Y Gastric Bypass to Sadi-S, with a Gastro-Gastric Jejunal Bridge as a Treatment of Obesity Recidivism: Case Report

There is a considerable weight regain after the Roux-en-Y gastric bypass (RYGB) surgery. Surgical conversion to more powerful metabolic techniques, like one anastomosis duodenal switch with sleeve gastrectomy (SADI-S), can be effective in this scenario, but surgically challenging. This case report aims to demonstrate technical modifications that simplifies the conversion of Roux-en-Y gastric bypass to SADI-S, in one stage. Female patient submitted to laparoscopic RYGB 10 years before with nadir of 29,47Kg/m². In the last 4 years, she had regained weight, reaching a body mass index of 46,48Kg/m². Surgical conversion was done laparoscopically, preserving the gastrojejunal anastomosis from the previous RYGB and the proximal 8cm of jejunal alimentary limb, which was transected at this level and used as a bridge between gastric pouch and antrum. Previously, the fundus, gastric body and part of the antrum were removed. The remaining alimentary limb, the gallbladder and the candy cane was removed. This was a single stage procedure, without complications. The interposition of the proximal alimentary limb of gastric bypass, between gastric pouch and antrum, has shown to be safe and feasible in RYGB conversion to SADI-S. The removal of the remnant alimentary limb makes the procedure shorter.info:eu-repo/semantics/publishedVersio

SADI-S with Extended Duodeno-Bulb Preservation: Case Report

Obesity has been growing in Brazil and in the world. It is reaching epidemic proportions, and bariatric surgery is the most effective treatment for patients with this disease. Among the procedures described in the literature, ileal surgeries such as biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) present better long-term results in terms of weight loss and comorbidities control. However, there are concerns regarding long term nutritional problems with these procedures. In this case report the aim is to demonstrate the technical feasibility of preserving an extended duodenal bulb segment, in the SADIS-S procedure, when there are difficulties in dissecting the retrobulbar region, as occurred here, due to fibrosis in this area. This assures the maintenance of the proposed surgical technique, in such a situation. The dissection and transection of the duodenum was done 7 cm distally to the pylorus, under endoscopic view, proximally to the papillae, where the tissue was normal. Additionally, due the importance of the duodenal mucosa on minerals and trace elements absorption and the release of important hormones in this region, this case report elicits the evaluation of the impact of this technical modification, which occurred casually, in the nutritional, hormonal and metabolic results, long term. In this case report, the extended duodenal length has demonstrated reasonable weight loss, adequate comorbidities control and good nutritional status, so far. These aspects must be evaluated in the long term, by clinical trials.info:eu-repo/semantics/publishedVersio

CHARACTERIZATION AND ANTIFUNGAL ACTIVITY OF THE ESSENTIAL OIL OF TAGETES MINUTA FRONT OF THE CRYPTOCOCCUS SPP. ISOLATES FROM THE ENVIRONMENT

Objective: This study evaluated the chemical composition and antifungal activity of the essential oil of inflorescences of Tagetes minuta (EOTM) belonging to the Asteraceae family against Cryptococcus spp. This microorganism is the encapsulated yeast-like and is recognized as an opportunistic fungal pathogen of great clinical importance.Methods: The inflorescences of T. minuta were collected in Itaara/RS, Brazil, in April 2013, and identification of the components was performed by GC-MS. The species of fungi are environmental isolates of Cryptococcus spp. identified by direct examination with India ink, urease test, culture and agar Niger medium canavanine glycine bromothymol blue, and all fungi isolates were confirmed by the use of automated panel MicroScan® Rapid Yeast ID (SIEMENS®). ATCC strains of C. gattii, C. neoformans and C. grubii belonging to the Microbiology Laboratory of the Centro Universitário Franciscano of Santa Maria/RS, Brazil were also used. The antifungal activity of the EOTM was evaluated by microdilution.Results: Most strains of Cryptococcus spp. were sensitive to EOTM even at low concentrations, except when the microorganism in question was Cryptococcus grubii which the essential oil showed a weak antifungal action.Conclusion: The EOTM appears as promising in prospecting for new drugs for the treatment of cryptococcosis.Keywords: Cryptococcosis, Natural products, Antifungal, Marigol

Cerebral tuberculomas in aids patients - A forgotten diagnosis?

The human immunodeficiency virus (HIV) infection epidemics increased the prevalence, multi-drug resistance and disseminated forms of tuberculosis. The central nervous system (CNS) tuberculosis has high mortality and morbidity, and it is usually divided into diffuse (meningitis) and localized (tuberculoma and abscess) forms. We report three cases of cerebral tuberculomas in AIDS patients: one with definitive diagnosis, confirmed with histopathology, and two with probable diagnosis, based on clinical information, radiological images, Mycobaterium tuberculosis isolation out of the CNS and adequate response to antituberculous treatment. Further, we discuss diagnostic, therapeutic and prognostic issues of tuberculomas, with emphasis in the distinction from cerebral tuberculous abscesses. Despite of their infrequent presentation, tuberculomas should be considered in the differential diagnosis of cerebral expansive lesions in patients with AIDS.623B79379

Arsenic exposure and outcomes of antimonial treatment in visceral leishmaniasis patients in bihar, India:a retrospective cohort study

Funding: This work was supported by a Clinical PhD Fellowship to MRP (090665) and a Principal Research Fellowship to AHF (079838) from the Wellcome Trust (http://www.wellcome.ac.uk). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Eficiência de fungicidas para o controle da mancha-alvo, Corynespora cassiicola, na safra 2012/13: resultados sumarizados dos ensaios cooperativos.

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Eficiência de fungicidas para o controle da ferrugem-asiática da soja, Phakopsora pachyrhizi, na safra 2010/11: resultados sumarizados dos ensaios cooperativos.

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